| NPI | 1780293969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 9539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036176512) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2025-09-02 |